Hyperlipidaemiák Szollár Lajos Klinikai kórélettan 2006. Szeptember 28

Hyperlipidaemiák

Szollár LajosKlinikai kórélettan

2006. Szeptember 28.

Metabolic pathways for endogenous and exogenous

lipids

The path of normal lipid metabolism

Reverse cholesterol transportReverse Cholesterol Transport

Peripheraltissuestissues

CellCellmembranemembrane

VLDL, IDL, LDLVLDL, IDL, LDL

LDLLDL receptorreceptor

LCATLCAT CETPCETPFCFC

CECECECE

TGTGHDLHDL HDL3HDL3

TGCE

Free cholesterolTriglyceridesCholesteryl esters

CETP Cholesteryl ester transfer proteinLCAT Lecithin cholesterol acyltransferase

SRB1SRB1

FC

ABCA1ABCA1

LiverLiver

HDL metabolism and reverse cholesterol transport

Regulation of cholesterol biosynthesis

LDL receptor

structure-function

relationship

A Utah pedigree with familial

hypercholestolaemia

Prevalence of tendon xanthomas and full circumference corneal arcus in

354 Utah patients

Factors altering the course of cardiovascular

disease

NCEP ATP III Guidelines (2004 proposed modifications)

Grundy SM et al. Circulation 2004;110:227-239.

Patients with

High risk: CHD orCHD risk equivalents(10-year risk >20%)

Initiate TLC* if LDL-C

100 mg/dL†

Drug therapy considered if LDL-C

100 mg/dL(<100 mg/dL: drug optional)

LDL-Cgoal

<160 mg/dL†

<130 mg/dL†

(optional goal:<100 mg/dL†)

<100 mg/dL†

(optional goal:<70 mg/dL†)

†70 mg/dL = 1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160 mg/dL = 4.1 mmol/L; 190 mg/dL = 5 mmol/L: * TLC: therapeutic lifestyle changes

Moderately high risk: >2 risk factors (10-year risk 10-20%)

Moderate risk: >2 risk factors (10-year risk <10%)

Lower risk: 0-1 risk factors

<130 mg/dL†

130 mg/dL†

130 mg/dL†

160 mg/dL†

130 mg/dL(100-129 mg/dL: drug optional)

160 mg/dL†

190 mg/dL†

(160-189 mg/dL: drug optional)

NCEP ATP III: LDL-C Goals (2004 proposed modifications)

*Therapeutic option in very high-risk patients and in patients with high TG, non-HDL-C<100 mg/dL; ** Therapeutic option; 70 mg/dL =1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160

mg/dL = 4.1 mmol/L

High RiskCHD or CHD risk

equivalents(10-yr risk >20%)

LDL-

C le

vel

100 -

160 -

130 -

190 -

Lower Risk

< 2 risk factors

Moderately High Risk≥ 2 risk factors

(10-yr risk 10-20%)

Target 160mg/dL

Target 130mg/dL

70 -

Target 100 mg/dL

or optional

70 mg/dL*

Moderate Risk

≥ 2 risk factors

(10-yr risk <10%)

Target 130 mg/dL

or optional 100

mg/dL**

Grundy SM et al. Circulation 2004;110:227-239.

LDL-koleszterin- szint egy nyugat-európai népességben:, fiziológiás

tartomány és terápiás célok.

Fiziológiástartomány

Célértékek

0.5 1.5 3.0 LDL-cholesterin mmol/L

Népesség frekvencia

2.51.8

Adapted from: O. Faergeman, S. M. Grundy. Dyslipidaemia. Elsevier. 2003

Impact of Recent Clinical Trials: Revised CAD Risk Categories

Estimate total CVD risk of fatal CVD event in 10 years

using SCORE chart

Total CVD risk <5%TC 5 mmol/L (190 mg/dL)

Total CVD risk 5% TC 5 mmol/L (190 mg/dL)

Measure fasting lipids, give lifestyle advice, with repeat lipids after

3 months

Lifestyle adviceAim: TC<5 mmol/L (190 mg/dL)LDL-C <3.0 mmol/L (115 mg/dL) Follow-up at 5-year intervals

TC <5 mmol/L (190 mg/dL) and LDL-C <3.0 mmol/L (115 mg/dL)

Maintain lifestyle advice with annual follow-up. If total risk remains 5%,

consider drugs to lower TC to <4.5 mmol/L(175 mg/dL) and LDL-C to <2.5 mmol/L (100 mg/dL)

TC 5 mmol/L (190 mg/dL) or LDL-C 3 mmol/L (115 mg/dL)

Maintain lifestyle advice and start drug

therapy

De Backer G et al. Eur Heart J 2003;24:1601–1610.

2003 European Guidelines:Guide to lipid management in asymptomatic

subjects

3rd European Guidelines Goals - Risk factors:

Prophylactic drug therapy should be considered in particular groups. These parameters have been

summarized as a mnemonic for the practitioner as the "European heart health telephone number":

14090530 140 mm Hg SBP 90 mm Hg DBP 5 mmol/L (150 mg/dL) total cholesterol 3 mmol/L (115 mg/dL) LDL cholesterol 0 NO SMOKING

Risk estimation is based on age, sex, smoking habits, systolic blood pressure (SBP), and either total cholesterol or cholesterol/HDL ratio.[7] Using the SCORE model, risk charts can be provided for all European countries. Total risk can be calculated from SCORE chartsThe low-risk chart is for countries such as Belgium. France, Greece, Italy, Luxembourg, Portugal, Spain, and Switzerland. Relative risk is calculated by comparing an individual's risk category with that of a nonsmoking person of the same age and gender with blood pressure </= 140/90 mm Hg and total cholesterol < 5 mmol/L (< 190 mg/dL).

Risk estimation is based on age, sex, smoking habits, systolic blood pressure (SBP), and either total cholesterol or cholesterol/HDL ratio.[7] Using the SCORE model, risk charts can be provided for all European countries. Total risk can be calculated from SCORE charts.The high-risk chart is for use in all other European countries. Relative risk is calculated by comparing an individual's risk category with that of a nonsmoking person of the same age and gender with blood pressure </= 140/90 mm Hg and total cholesterol < 5 mmol/L (< 190 mg/dL).

II. Magyar Terápiás Konszenzus Ajánlása kardiovaszkuláris betegségek

megelőzéséről és preventív kezelésérőlHáziorvos Továbbképzô Szemle 2006; 11: 131–138

II. Magyar Terápiás Konszenzus Ajánlása kardiovaszkuláris betegségek

megelőzéséről és preventív kezelésérőlHáziorvos Továbbképzô Szemle 2006; 11: 131–138